HomeMy WebLinkAboutMiscellaneous - Abby LaneMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number
WPA Form 7 — Extension Permit for Orders of Conditions 242-1296
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. General Information
Important:
When filling out 1.
Applicant:
forms on the
North Andover Realty Corpo
computer, use
Name
only the tab
key to move
459 East Broadway
your cursor -
Mailing Address
do not use the
Haverhill
return key.
CityrFown
Q 2.
Property Owner (if different):
reMn
Same
Name
Mailing Address
CitylTown
ration
MA
State
State
01830
Zip Code
B. Authorization
The Order of Conditions (or Extension Permit) issued to the applicant or property owner listed above on:
Date[
for work at:
Molly Towne Road (Autumn Chase Subdivision)
Street Address
recorded at the Registry of Deeds for:
Essex North
County
Certificate (if registered land)
is hereby extended until:
6/22109
Date
Map 38 & Map 65
Assessor's Map/Plat Number
9631
Book
Parcels 41, 24
& 33
Parcel/Lot Number
84
Page
This date can be no more than 3 years from the expiration date of the Order of Conditions or the latest
extension. Only unexpired Orders of Conditions or Extension may be extended.
Date the Order was last extended (if applicable):
Issued by:
North Andover
Conservation Commission
Date
Date
wpaform7.doc • rev. 1/07 Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 7 — Extension Permit for Orders of Conditions 242-1296
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Authorization (cont.)
This Order of Conditions Extension must be signed by a majority of the Conservation Commission
and a copy sent to the applicant and the appropriate DEP Regional Office (see
httiD://www. mass. oov/deD/about/reaion/findvour. htm)
Signatures:
Notary Acknowledgement
Commonwealth of Massachusetts County of
1.
On this Day
I
Essex North
of �'
r
0`t .J� er o'ZL�fJ�
Month Year
Before me, the undersigned Notary Public, personally appeared
Scott tia,5s'
Name of Signer
proved to me through satisfactory evidence of identification, which was/were
Massachusetts License
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged to
me that he/she signed it voluntarily for its stated purpose.
As member of
7n,NA M. WEDGE
.""y PUOL!C
"ETTS
,g
North Andover
City/Town
Place notary seal and/or any stamp above
Conservation Commission
� C, /�Iv �
Signature of Notary Public
64 21214 !�? 1�116 DG6=
Printed Name of Notary Public
171,20 q
My Comm ssio xpires (Date)
wpaform7.doc • rev. 1/07 Page 2 of 4
Massachusetts Department of Environmental Protection
DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 7 — Extension Permit for Orders of Conditions 242-1296
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Recording Confirmation
The applicant shall record this document in accordance with General Condition 8 of the Order of
Conditions (see below), complete the form attached to this Extension Permit, have it stamped by the
Registry of Deeds, and return it to the Conservation Commission.
Note: General Condition 8 of the Order of Conditions requires the applicant, prior to commencement of
work, to record the final Order (or in this case, the Extension Permit for the Order of Conditions) in the
Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of
the affected property. In the case of recorded land, it shall be noted in the Registry's Granter Index under
the name of the owner of the land upon which the proposed work is to be done. In the case of registered
land, it shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the
proposed work is done.
Detach page 3 of Form 7 and submit it to the Conservation Commission prior to the expiration of the
Order of Conditions subject to this Extension Permit.
To:
North Andover
Conservation Commission
Please be advised that the Extension Permit to the Order of Conditions for the project at:
Autumn Chase Subdivision 242-1296
Project Location DEP File Number
has been recorded at the Registry of Deeds of:
Essex North
County
for:
Property Owner
and has been noted in the chain of title of the affected property in accordance with General Condition 8 of
the original Order of Conditions on:
Date
Book Page
If recorded land the instrument number which identifies this transaction is:
Instrument Number
If registered land, the document number which identifies this transaction is:
Document Number
Signature of Applicant
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